considerations for moving forward
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Considerations for Moving Forward. Health Foundation of Greater Cincinnati August 17, 2007. Cindy Mann Executive Director Georgetown University Health Policy Institute Center for Children and Families. Trends & Current Status. The Uninsured in America. - PowerPoint PPT PresentationTRANSCRIPT
Considerations for Moving Forward
Cindy MannExecutive Director
Georgetown University Health Policy InstituteCenter for Children and Families
Health Foundation of Greater CincinnatiAugust 17, 2007
44.8
43.543.4
42
39.8
38.438.8
1999 2000 2001 2002 2003 2004 2005
The Uninsured in America
Number of Total Uninsured in Millions
Source: U.S. Census Bureau, Current Population Survey, 2000 to 2006 Annual Social and Economic Supplements, (released June 28, 2007)
22.3%
21.5%
20.1% 20.0%
18.0%
15.8% 15.9%
14.9%15.2%
1997 1998 1999 2000 2001 2002 2003 2004 2005
Uninsured rate of low-income children under 19
Trends in the Uninsured Rate of Low-Income Children, 1997- 2005
Source: CCF analysis of National Health Interview Survey.
Note: “Low-income” is defined as having income below 200% of the federal poverty line, which in 2005 was $32,180 for a family of 3.
Why the Big Difference?
• ESI declining for adults and children
• Children much more likely to be eligible for public programs (Medicaid/SCHIP) which fill in the gaps
Premiums for Employer-Sponsored Coverage Are Growing Faster than Workers Earnings
13.9%
7.7%
3.8%
5.3%
8.2%
10.9%
12.9%
11.2%
9.2%
3.8%2.7%
2.1%3.0%
2.6%
4.0%3.9%3.6%
4.4%
0%
2%
4%
6%
8%
10%
12%
14%
16%
1998 1999 2000 2001 2002 2003 2004 2005 2006
Health Insurance Premiums Workers Earnings
Note: The annual growth for premiums is statistically significant from the prior year at p<0.05 for every year except 2003.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006, (September 2006).
Changes in Health Insurance Coverage, 2000-2004
-4.6% -4.6%
1.2%
5.2%
2.7%
-0.7%
Employer Medicaid/SCHIP Uninsured
Adults Children
Source: Urban Institute, 2005, for Kaiser Commission on Medicaid and the Uninsured
(6.3 million more uninsured adults)
(300,000 fewer uninsured children)
10.4%
29.7%
Kentucky, 17.8%
Ohio, 14.3%
U.S. Average, 19.7%
State Uninsurance Rates of Nonelderly Adults (2005)
Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).
20%
4.8%
Kentucky, 7.8%
Ohio, 8.1%
U.S. Average, 11%
State Uninsurance Rates of Children (2005)
Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).
Employer62%
Individual5%
Medicaid/SCHIP
14%
Other Public
2%
Uninsured
17%
Sources of Coverage for Nonelderly Americans, 2004-2005
256 Million Nonelderly Americans
Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).
Sources of Coverage for Nonelderly Kentuckians & Ohioans, 2004-2005
Employer62%
Individual4%
Medicaid/SCHIP15%
Other Public
4%
Uninsured15%
3.6 Million Nonelderly Kentuckians
Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).
Employer68%
Individual4%
Medicaid/SCHIP13%
Other Public
2%
Uninsured13%
9.9 Million Nonelderly Ohioans
Characteristics of the Nonelderly Uninsured, 2005
Adults 19-3440%
Adults 35-6440%
Children under
1920%
200-399% FPL23%
400%+ FPL10%
100-199% FPL30%
< 100% FPL37%
Age
Source: Urban Institute, 2005, for Kaiser Commission on Medicaid and the Uninsured
Part-time
worker11%
No worker
19%
1 or more full-
time worker
70%
Work StatusIncome
44.4 Million Nonelderly Americans
Health Care Is An Important Priority for Americans
1. Iraq (20%)
2. Terrorism/national security (17%)
3. Economy/jobs (17%)
4. Health care (16%)
5. Immigration (10%)
6. Education (8%)
7. Environment (7%)
The most important issue to voters in deciding who they would like to see elected president (July 2007):
Source: CBS News/New York Times Poll, July 9-17, 2007.
Private Dollars15%
Federal Dollars58%
State Dollars27%
Payment Sources for Uncompensated Care, 2004
Total = $40.7 Billion
Source: Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer, (October 2006).
There Is Not A Consensus on Solutions
The public’s most preferred policy option to help the uninsured:
12%
13%
15%
17%
17%
23%
Expand Medicare to cover uninsuredpeople 55 and over
Require businesses to offer insurance
Create a national, single-payer healthplan
Offer tax incentives to the uninsuredto help them purchase insurance
Expand Medicaid, SCHIP, and otherstate programs
Offer tax incentives to businesses tohelp provide insurance
Source: Kaiser/Harvard Health Care Agenda for the New Congress Survey (conducted November 4-28, 2004).
A Big Divide?
• “We need universal health care coverage in this country, not stale ideas and savings account schemes.”
- AFL-CIO President John Sweeney (February 1, 2006)
• “I emphasize private insurance, the best health care plan -- the best health care policy is one that emphasizes private health. In other words, the opposite of that would be government control of health care.”
- President George W. Bush (June 27, 2007)
More Action at the State Level
• Children’s coverage
• Universal coverage
• In between?
• Insurance reforms, tax changes
AZAR
MS
LA
WA
MN
ND
WY
ID
UTCO
OR
NV
CA
MT
IA
WIMI
NE
SD
ME
MOKS
OHIN
NY
IL
KY
TNNC
NH
MA
VT
PA
VAWV
CT
NJ
DE
MD
RI
HI
DC
AK
SC
NMOK
GA
Source: As of August 2, 2007 based on CCF review of state initiatives.
TX
IL
FL
AL
Implemented or Recently Adopted Legislation to Improve Children’s Coverage (26 states and DC)
Considering Significant Proposal to Improve Children’s Coverage (2 states)
States are Moving ForwardOn Children’s Coverage
Americans Support Covering Children
91%91%July 23, 2007
Source: Poll conducted by Lake Research Partners and American Viewpoint, national survey of 1,002 American voters from June 26 - July 1, 2007 for the Center for Children and Families
200%
65%
Children Parents
But Their Parents Are Often Left BehindMedicaid/SCHIP Eligibility Levels for Children and
Parents With Earnings in the Median State
Source: CBPP survey for KCMU, January 2007.Note: In 2007, 65% of the FOL is equal to $11,161 for a family of 3.
Income Eligibility Levels Expressed as a Percent of the Federal Poverty Level
“Universal” Coverage
• Enacted: Massachusetts, Vermont
• Partial: Maine
• Under active debate: California, Illinois, Maine, Pennsylvania, Washington
• Commissions, studies going on in several states
23.90%
40.20%
11.30%
U.S. Kentucky Ohio
Solutions Are At Hand
Decline in the Rate of Uninsured Children, 1997/1998 to 2004/2005
Source: RWJF, Protecting America’s Future: A State-by-State Look at SCHIP & Uninsured Kids, (August 2007).
Elements For Success
• It doesn’t happen overnight• Advocacy/organizing capacity is essential
– Look for opportunities for common ground
• For several reasons, public program coverage is key
• Solutions are at hand, but they aren’t free• Much can be done at the state level but the
federal government will need to step to the plate